Soluções cirúrgicas combinadas para o sorriso gengival / Surgical combined solutions for the gummy smile

A estética vem sendo cada vez mais requisitada em nossos consultórios, dada a sua divisão entre "estética branca" e "estética vermelha". A gengiva compõe um belo sorriso de maneira tão importante quanto os dentes. A exposição gengival excessiva gera desarmonia estética e é denominada sorriso gengival. O tratamento do sorriso gengival vem sendo cada vez mais desmistificado e apresenta maior procura e aceitação por parte dos pacientes. Do ponto de vista periodontal, pode-se realizar gengivoplastia e gengivectomia com bisel interno ou externo, com ou sem osteotomia, dependendo da etiologia e características periodontais do paciente. No presente estudo, foram realizadas, na mesma paciente, a técnica de bisel interno no arco superior e a técnica de bisel externo no inferior. Buscou-se, assim, esclarecer em qual momento cada técnica é indicada.

Esthetics has been a common issue in the dental offi ce, for this being divided into "white" and "pink" esthetics. The gingival tissue is so fundamental as the dental element in the smile composition. Excessive gingival display results in what has been known as the gummy smile. The proposed treatments have been simplifi ed and more and more requested by patients. From the periodontal point of view, the gingivoplasty and the gingivectomy can be made with internal or external bevel, with or without osteotomy, depending on the etiology and periodontal characteristics. In this case report, the internal bevel technique was performed in the maxillary arch and the external bevel technique in the mandibular arch. The indications for both techniques are discussed here.

Surgical Treatment of 846 Patients with Benign Skin Tumors: Experience of a Dermatologic Surgeon in Korea / 대한피부과학회지

BACKGROUND: The incidence of skin tumors has been increasing over the past few years due to an aging population, environmental changes, and improved access to medical institutions. OBJECTIVE: To report the rate of relapse and complications after surgical treatment, and suggest appropriate ways of treating benign skin tumors. METHODS: We performed a retrospective review of 846 patients with benign skin tumors who were diagnosed and treated by a single dermatosurgeon. RESULTS: Of the 846 patients, 18 (2.1%) developed local recurrence. Epidermal cysts (15/390) were the most common skin condition, followed by lipomas (2/149). The recurrence rate of epidermal cysts showed no statistical difference when treatment options and the presence of inflammation or suppuration at the first visit were considered. Six patients (0.7%, 6/846) had one of the complications such as persistent inflammation over one month, severe pain, secondary infection, or skin necrosis. All the lipomas following recurrence or those with complications were located in the intramuscular or submuscular area of the forehead, which were easily localized by sonography. CONCLUSION: Surgery is a valuable method for the treatment of benign skin tumors with low rates of complication and relapse. For better outcomes after treatment, dermatologists should attempt to remove these tumors completely and consider the use of imaging studies before treatment.

Clinical study of surgical treatments for snoring and obstructive sleep apnea

PURPOSE: Clinical study to evaluate the efficacy and the safety of various surgical treatments in snoring and obstructive sleep apnea. METHODS AND MATERIALS: We performed surgical treatments such as radiofrequency ablation, uvulopalatopharyngoplasty(UPPP) with tonsillectomy, uvulopalatopharyngoplasty with advancement genioplasty, orthognathic surgery(maxillomandibluar advancement), distraction osteogenesis device insertion. Diagnosis was performed with clinical examination, polysomnography, lateral cephalometric and computed tomography. 62(M : F = 45 :17 , mean age 41.5, mean follow-up 4 weeks) patients underwent radiofrequency ablation and 7(M : F = 5 : 2, mean age 38.9, mean follow-up 19months)patients experienced uvulopalatopharyngoplasty with tonsillectomy. Uvulopalatophayngoplasty with advancement genioplasty was performed for 3 (M : F = 2: 1, mean age 30.2 , mean follow-up 14 months)patients. The last 3(M : F = 2 : 1, mean age 21.5 , mean follow-up 24 months)patients was treated with orthognathic surgery including distraction device insertion. The results was evaluated by questionnaires, polysomnography, investigation of complications. RESULTS: Of the patients treated with radiofrequency ablation, 95% reported improvement of their symptom. 100% improvement was reported in patients treated with UPPP with tonsillectomy and UPPP with advancement genioplasty. The two of three patients who underwent orthognathic surgery showed the satisfactory of treatments. Dryness of mouth was the most common complication during short period in radiofrequency ablation and UPPP with tonsillectomy. Relapse complication was not found in any surgical treatments. CONCLUSION: Treatment for snoring and OSA is determined by severity degree of the physiologic derangements, predominant type of apnea and obstructive site. Accuracy diagnosis should be performed prior to treatment for satisfactory treatment result. This study demonstrates feasibility, safety and efficacy of surgical treatments in snoring and OSA.

The Occlusal Force and EMG Change after BSSRO

BSSRO is most frequently operated among orthognathic surgery techniques for repairment of maxillofacial deformities. In case of patients with maxillofacial asymmetry accompanying mandibular protrusion who are operated by BSSRO, this study considers the recovering time for masticatory force of each tooth and Masseteric EMG and the adequate time enabling normal occlusion. The patients who are operated with BSSRO under general anesthesia in Dankook Dental Hospital, Department of OMS are selected for this study. The control group is devided into 2. 26 patients with facial asymmetry accompanying mandibular protrusion are selected for group 1 and their maximum voluntary bite force and masseteric EMG are measured. Group 2 is formed by volunteers with healthy dentition who are measured maximum bite force and masseteric EMG on both sides of the mouth. At the week of 3rd, 5th, 7th, 9th and 11th, Mann-Whitney U test is carried on for statistical analysis and the result is as follows. 1. Patients with mandibular protrusion showed apparently low maximum bite force and masseteric EMG than patients with normal occlusion. 2. In comparison with control group 1, Occlusal force is regained in incisors and canines at the 9th week and in premolars and molars, 11th week and masseteric EMG is regained at 11th week. 3. Comparing to normal occlusal patients, no recovery could be found in experimental group in every parts of the mouth.

Surgical Treatments of the Pediatric Intractable Epilepsy: A Single Center Experience / 대한간질학회지

PURPOSE: This study evaluates and compares the surgical outcomes of pediatric intractable epilepsy from various surgical modalities. METHODS: Among the patients who underwent epileptic surgery from March 1996 to February 2001, only the children, who had at least one year follow-up, were included in this study. The mean age with first seizure attacks was 3.5 years. The interval between first seizure attacks and surgical treatment was 4.8 years on average, and the mean age at surgical management was 7.4 years. The possible etiology was observed in 75.4% of total patients. Brain tumor and cortical dysplasia were main causes. The surgical treatment was done with various modalities, including resective surgeries (49.2%), corpus callosotomy of disconnection methods (41.5%), combined surgeries (7.7%), and gamma knife radiosurgery (one case). RESULTS: Surgical outcomes were evaluated based on the Engel's classification. After resective surgery, 90.6% of the patients showed class I. The majority of corpus callosotomy (59.3%) had class III. The outcomes after combined surgeries ranged from class I to III. The result of gamma knife radiosurgery was class III. The pathologic findings from resected tissue showed cortical dysplasia, tumor, nonspecific gliosis, etc. The complications after surgery were transient or permanent hemiparesis, visual field defect, hydrocephalus, subdural effusion, etc. CONCLUSION: We performed the various surgical methods in children with medically intractable epilepsy and obtained different results by surgical modalities. The surgical outcome will be improved if there is an appropriate selection among surgical modalities through the various preoperative assessments.

Surgical Treatment of Metastatic Bone Tumors / 대한정형외과학회잡지

Metastatic bone tumors can lead to development of pathological fractures which may cause incessant pain. Hypercalcemia and hypercalciuria may develop secondary to skeletal metastasis and recumbency, leading to death from cardiac and renal sequeale. The proper surgical treatments of the metastatic bone tumor offer many advantages in relief of pain, simplifying nursing care, restoring resonable mobility and prevent complications. The authors reviewed 24 cases of metastatic bone tumors which received surgical treatment at Severance Hospital from January 1976 to March 1982. The results were obtained as follows: 1. Twenty four among three hundred patients with metastatic bone tumors were treated surgically. 2. There was no sexual preference and 66.7% were observed in the age of 51 to 70 group. 3. The most common site of operation was the femur. 4. The methods of operation were as follows: Resectionoflesion.....................5 Replacement with prosthesis..........3 Open reduction and internal..........10 Spinal fusion..........................2 Laminectomy............................4 5. All cases had received various types of ancillary treatment: radiation in 8 cases, 131I radioactive isotope in 1 case, chemotherapy in 2 cases, hormone therapy in 1 case, radiation and chemotherapy in 3 cases and conservative pain control in 9 cases. 6. Among the 15 followed cases, nine survived more than 6 months and 3 cases longer than 1 year after surgery. The pain was relieved markedly in twenty-three patients, and ambulated well with brace support.